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WHO change at the top

By Professor Stephen Leeder, Emeritus Professor Public Health, University of Sydney

Tedros Adhanom Ghebreyesus is not a household name

Nor for that matter is the World Health Organisation, to which, last month he was elected to lead as Director-General for the next four years.

Tedros, as he is known, is not medically qualified — the first such person to lead the WHO — but has a PhD in Community Health. He comes from Ethiopia, where he has served as Minister for Foreign Affairs and for Health. In his late 50s, he has an impressive track record of health service development in his home country, an especially remarkable feat in such an economically and environmentally challenged nation.

The appointment of directors-general at WHO has become increasingly political, but also, ironically, more transparent. As Laurie Garrett, an eminent health journalist from the New York-based Council for Foreign Relations put it: “This year, by the time the Seventieth World Health Assembly opened on May 22, the electioneering [among candidates for the director-generalship] evidenced many of the trappings of a typical high-level campaign in a Western democracy, including professional campaign staffing, social media messaging, last-minute rumours and mudslinging, speeches, handshaking marathons, and last minute rabble-rousing fêtes.

“The election was held on May 23. According to the voting rules, each country was limited to four individuals inside the assembly hall in the Palais des Nations [in Geneva], where all emailing, tweeting, and texting was strictly verboten.

“Locked into the hall, the delegates for the 186 nations that qualified to cast written ballots—by virtue of being up-to-date on their WHO dues and being physically present in Geneva—cast three rounds of votes while hundreds of media and assembly attendees milled about outside, hoping for news. The new rules dictated that a candidate had to win a 66 percent majority, which Tedros (who led every round) achieved on the third vote, handily defeating second-place [David] Nabarro [of the UK]. The votes were cast by secret written ballots, placed inside boxes and hand-counted by WHO officials.”

The WHO has huge responsibilities for global health and well-being, but we hardly notice. Western politics has become so polarised and focussed on individuals that global activities and events — with the exception of climate change, tensions with Russia and North Korea and terrorism — get little oxygen in our conversations.

But the state of health of much of the earth remains poor. And it is for this reason that WHO — even though it has its own political rough and tumble — is so important to securing a humane future for the planet. Its leadership is vital, setting the tone and doing the work.

The cookie jar is empty

But it has been held to ransom by major contributors to its coffers to do things which would selectively benefit themselves. The WHO’s finances are in bad shape. Its annual budget is around the $2 billion mark. As an organisation, it has had terrible troubles with near-bankruptcy, fierce competition from groups such as the Gates Foundation, the World Bank and the International Monetary Fund, each with its own, often narrow, agenda and barrels of cash, and immense pressure from industries — food, private medicine and pharmaceutical giants, to name but three.

With Trump’s plan to cut contributions to anything truly international that is not an anabolic steroid boost for the US, the contribution from its principal international donor looks set to fall. Our falling foreign aid funding follows the same path. The capacity of the WHO will, nevertheless, somehow need to be strengthened as part of global readiness for the next pandemic. This will require economic engineering of a high order.

WHO has survived many vicissitudes in its 69 years. Tedros clearly has intelligence, experience and leadership skills, together with wide political support within the organisation. The world’s health care is wobbly at present. He will need good proprioception and vision to keep his balance! Let’s wish him well.